Vulnerable diseases affecting child mortality in Sierra Leone: emerging health issue

Child mortality in Sierra Leone is the highest ranked in the world. The main causes for child mortality are maternal factors, environmental factors and health factors. Minimal research has been carried out on health factors in Sierra Leone. The objective of this study is to see how maternal and environmental factors have an effect on health factors, which in turn cause child mortality. The data used were from the 2008 Sierra Leone Demographic and Household Survey (SLDHS). The study showed that child mortality had statistically significant factors associated with it: place of residence, birth number, religion and type of toilet facility. Furthermore, the SLDHS had not given much information regarding the cause of diseases affecting children, so we looked only at the effects they had on children. Acute respiratory infections, diarrhoea and measles each had one variable that was statistically significant. As for pneumonia, there were no variables associated with children contracting the disease

Using Discrete Choice Experiment with duration to model EQ-5D-5L health state preferences: Testing experimental design strategies

Background: Discrete choice experiments incorporating duration can be used to derive health state values for EQ-5D-5L. Yet, methodological issues relating to the duration attribute and the optimal way to select health states remain. The aims of this study were to: test increasing the number of duration levels and choice sets where duration varies (aim 1); compare designs with zero and non-zero prior values (aim 2); and investigate a novel, two-stage design to incorporate prior values (aim 3). Methods: Informed by zero and non-zero prior values, two efficient designs were developed, each consisting of 120 EQ-5D-5L health profile pairs with one of six duration levels (aims 1 and 2). Another 120 health state pairs were selected, with one of six duration levels allocated in a second stage based on existing estimated utility of the states (aim 3). An online sample of 2,002 members of the UK general population completed 10 choice sets each. Differences across the regression coefficients from the three designs were assessed. Results: The zero prior value design produced a model with coefficients that were generally logically ordered, but the non-zero prior value design resulted in a set of less ordered coefficients where some differed significantly. The two-stage design resulted in ordered and significant coefficients. The non-zero prior value design may include more “difficult” choice sets, based on the proportions choosing each profile. Conclusions: There is some indication of compromised “respondent efficiency”, suggesting that the use of non-zero prior values will not necessarily result in better overall precision. It is feasible to design discrete choice experiments in two stages by allocating duration values to EQ-5D-5L health state pairs based on estimates from prior studies

Nets, Spray or Both? The Effectiveness of Insecticide-Treated Nets and Indoor Residual Spraying in Reducing Malaria Morbidity and Child Mortality in sub-Saharan Africa.

Malaria control programmes currently face the challenge of maintaining, as well as accelerating, the progress made against malaria with fewer resources and uncertain funding. There is a critical need to determine what combination of malaria interventions confers the greatest protection against malaria morbidity and child mortality under routine conditions. This study assesses intervention effectiveness experienced by children under the age of five exposed to both insecticide-treated nets (ITNs) and indoor residual spraying (IRS), as compared to each intervention alone, based on nationally representative survey data collected from 17 countries in sub-Saharan Africa. Living in households with both ITNs and IRS was associated with a significant risk reduction against parasitaemia in medium and high transmission areas, 53% (95% CI 37% to 67%) and 31% (95% CI 11% to 47%) respectively. For medium transmission areas, an additional 36% (95% CI 7% to 53%) protection was garnered by having both interventions compared with exposure to only ITNs or only IRS. Having both ITNs and IRS was not significantly more protective against parasitaemia than either intervention alone in low and high malaria transmission areas. In rural and urban areas, exposure to both interventions provided significant protection against parasitaemia, 57% (95% CI 48% to 65%) and 39% (95% CI 10% to 61%) respectively; however, this effect was not significantly greater than having a singular intervention. Statistically, risk for all-cause child mortality was not significantly reduced by having both ITNs and IRS, and no additional protectiveness was detected for having dual intervention coverage over a singular intervention. These findings suggest that greater reductions in malaria morbidity and health gains for children may be achieved with ITNs and IRS combined beyond the protection offered by IRS or ITNs alone

Health-industry linkages for local health: reframing policies for African health system strengthening

The benefits of local production of pharmaceuticals in Africa for local access to medicines and to effective treatment remain contested. There is scepticism among health systems experts internationally that production of pharmaceuticals in sub-Saharan Africa (SSA) can provide competitive prices, quality and reliability of supply. Meanwhile low-income African populations continue to suffer poor access to a broad range of medicines, despite major international funding efforts. A current wave of pharmaceutical industry investment in SSA is associated with active African government promotion of pharmaceuticals as a key sector in industrialization strategies. We present evidence from interviews in 2013–15 and 2017 in East Africa that health system actors perceive these investments in local production as an opportunity to improve access to medicines and supplies. We then identify key policies that can ensure that local health systems benefit from the investments. We argue for a ‘local health’ policy perspective, framed by concepts of proximity and positionality, which works with local priorities and distinct policy time scales and identifies scope for incentive alignment to generate mutually beneficial health–industry linkages and strengthening of both sectors. We argue that this local health perspective represents a distinctive shift in policy framing: it is not necessarily in conflict with ‘global health’ frameworks but poses a challenge to some of its underlying assumptions

Production Trends, Collaboration, and Main Topics of the Integrative and Complementary Oncology Research Area: A Bibliometric Analysis

Background: The prevalence of cancer has increased over time worldwide. Nevertheless, the number of deaths has been reduced during the past 2 decades. Thus, one-third of the cancer patients are users of complementary and alternative therapies, looking for other types of interventions. The main aim of the present study is to understand the current status of the research in integrative and complementary oncology. Three different aspects were analyzed: production trends, country collaboration, and leading research topics. Methods: The dataset was obtained from the documents indexed under the Integrative and Complementary Medicine category of the Web of Science database from 1976 to 2017. VOSviewer and SciMAT software were employed to perform the bibliometric analysis. Results: The Journal of Ethnopharmacology, China Medical University and the People’s Republic of China are the leading producers in the field. Regarding the collaboration, the United States and China present a close connection. The scientific community is focused on the following topics: apoptosis, breast cancer, oxidative stress, chemotherapy, and nuclear factor-Kappa-B (NF-Kappa-B). Conclusions: The present article shows potentially important information that allows understanding of the past, present, and future of research in integrative and complementary oncology. It is a useful evidence-based framework on which to base future research actions and academic directions

Einstein-Weyl structures corresponding to diagonal K\"ahler Bianchi IX metrics

We analyse in a systematic way the four dimensionnal Einstein-Weyl spaces equipped with a diagonal K\"ahler Bianchi IX metric. In particular, we show that the subclass of Einstein-Weyl structures with a constant conformal scalar curvature is the one with a conformally scalar flat - but not necessarily scalar flat - metric ; we exhibit its 3-parameter distance and Weyl one-form. This extends previous analysis of Pedersen, Swann and Madsen , limited to the scalar flat, antiself-dual case. We also check that, in agreement with a theorem of Derdzinski, the most general conformally Einstein metric in the family of biaxial K\"ahler Bianchi IX metrics is an extremal metric of Calabi, conformal to Carter's metric, thanks to Chave and Valent's results.Comment: 15 pages, Latex file, minor modifications, to be published in Class. Quant. Gra

Burden of disease attributable to suboptimal diet, metabolic risks, and low physical activity in Ethiopia and comparison with Eastern sub-Saharan African countries, 1990-2015: findings from the Global Burden of Disease Study 2015

Background: Twelve of the 17 Sustainable Development Goals (SDGs) are related to malnutrition (both under- and overnutrition), other behavioral, and metabolic risk factors. However, comparative evidence on the impact of behavioral and metabolic risk factors on disease burden is limited in sub-Saharan Africa (SSA), including Ethiopia. Using data from the Global Burden of Disease (GBD) Study, we assessed mortality and disability-adjusted life years (DALYs) attributable to child and maternal undernutrition (CMU), dietary risks, metabolic risks and low physical activity for Ethiopia. The results were compared with 14 other Eastern SSA countries. Methods: Databases from GBD 2015, that consist of data from 1990 to 2015, were used. A comparative risk assessment approach was utilized to estimate the burden of disease attributable to CMU, dietary risks, metabolic risks and low physical activity. Exposure levels of the risk factors were estimated using spatiotemporal Gaussian process regression (ST-GPR) and Bayesian meta-regression models. Results: In 2015, there were 58,783 [95% uncertainty interval (UI): 43,653-76,020] or 8.9% [95% UI: 6.1-12.5] estimated all-cause deaths attributable to CMU, 66,269 [95% UI: 39,367-106,512] or 9.7% [95% UI: 7.4-12.3] to dietary risks, 105,057 [95% UI: 66,167-157,071] or 15.4% [95% UI: 12.8-17.6] to metabolic risks and 5808 [95% UI: 3449-9359] or 0.9% [95% UI: 0.6-1.1]to low physical activity in Ethiopia. While the age-adjusted proportion of all-cause mortality attributable to CMU decreased significantly between 1990 and 2015, it increased from 10.8% [95% UI: 8.8-13.3] to 14.5% [95% UI: 11.7-18.0] for dietary risks and from 17.0% [95% UI: 15.4-18.7] to 24.2% [95% UI: 22.2-26.1] for metabolic risks. In 2015, Ethiopia ranked among the top four countries (of 15 Eastern SSA countries) in terms of mortality and DALYs based on the age-standardized proportion of disease attributable to dietary risks and metabolic risks. Conclusions: In Ethiopia, while there was a decline in mortality and DALYs attributable to CMU over the last two and half decades, the burden attributable to dietary and metabolic risks have increased during the same period. Lifestyle and metabolic risks of NCDs require more attention by the primary health care system of in the country

Academic research groups: evaluation of their quality and quality of their evaluation

In recent years, evaluation of the quality of academic research has become an increasingly important and influential business. It determines, often to a large extent, the amount of research funding flowing into universities and similar institutes from governmental agencies and it impacts upon academic careers. Policy makers are becoming increasingly reliant upon, and influenced by, the outcomes of such evaluations. In response, university managers are increasingly attracted to simple indicators as guides to the dynamics of the positions of their various institutions in league tables. However, these league tables are frequently drawn up by inexpert bodies such as newspapers and magazines, using rather arbitrary measures and criteria. Terms such as "critical mass' and "metrics" are often bandied about without proper understanding of what they actually mean. Rather than accepting the rise and fall of universities, departments and individuals on a turbulent sea of arbitrary measures, we suggest it is incumbent upon the scientific community itself to clarify their nature. Here we report on recent attempts to do that by properly defining critical mass and showing how group size influences research quality. We also examine currently predominant metrics and show that these fail as reliable indicators of group research quality.Comment: Presented at the International Conference on Computer Simulation in Physics and Beyond in Moscow, 2015. The Proceedings will appear in Journal of Physics: Conference Series (JPCS

PERANAN PENGENDALIAN INTERN DALAM MENUNJANG EFEKTIVITAS SISTEM PEMBERIAN PEMBIAYAAN PADA BMT DUTA JAYA UNIT 2 TULANG BAWANG

Baitul Mal wat Tamwil (BMT) Duta Jaya Unit 2 Tulang Bawang dalam kegiatan pembiayaan agar dapat berjalan dengan baik dan sesuai dengan prosedur, maka perlu diterapkan sistem pengendalian intern berdasarkan SOP (Standard Operating Procedure). Pengendalian intern merupakan suatu mekanisme pengawasan yang ditetapkan oleh manajemen dalam guna meningkatkan kepatuhan terhadap ketentuan yang berlaku, mengurangi dampak kerugian, penyimpangan, termasuk kecurangan, dan pelanggaran dengan aspek kehati-hatian, meningkatkan efektivitas organisasi dan efesiensi biaya. Permasalahan yang dikaji dalam penelitian ini adalah apakah pengendalian intern telah diterapkan pada BMT Duta Jaya Unit 2 Tulang Bawang, bagaimanakah peranan pengendalian intern dalam menunjang efektivitas pemberian pembiayan pada BMT Duta Jaya Unit 2 Tulang Bawang, bagaimanakah pengendalian intern pada BMT Duta Jaya Unit 2 Tulang Bawang dalam pandangan Islam. Penelitian ini bertujuan untuk mengetahui pengendalian intern dalam menunjang efektivitas sistem pemberian pembiayaan dan penerapan pengendalian intern pada BMT Duta Jaya Unit 2 Tulang Bawang dalam pandangan Islam. Penelitian ini menggunakan teknik analisa data yang bersifat deskriptif-kualitatif. Teknik pengumpulan data yang digunakan adalah obsevasi, wawancara, dan dokumentasi. Populasi yang menjadi objek penelitian ini adalah BMT Duta Jaya Unit 2 Tulang Bawang. Sampel yang digunakan pada penelitian ini adalah purposive sampling, sehingga sampling yang menjadi objek penelitian ini adalah 4 orang karyawan dan nasabah yang terkait. Hasil penelitian peranan pengendalian intern dalam menunjang efektivitas sistem pemberian pembiayaan bahwa BMT Duta Jaya Unit 2 Tulang Bawang telah menerapkan pengendalian intern, yaitu peraturan dalam pemisahan tugas dan tanggung jawab atau wewenang yang baik dengan membentuk struktur organisasi baik itu dalam pelaporan keuangan ataupun peraturan kegiatan operasional lainnya, peraturan dalam etika dan kejujuran yang harus dimilki oleh setiap karyawan, peratur kepatuhan kedisplinan, dan peraturan dalam proses pemberian pembiayaan pada calon nasabah yang diatur berdasarkan SOP (Standard Operating Procedur) yang ditetapkan. Meski adanya kekurangan pengendalian intern dalam BMT Duta Jaya Unit 2 Tulang Bawang, kekurangan dalam keterbatasan sumber daya manusia dalam operasional, pengawasan pusat yang tidak teratur, dan sistem pembuatan laporan keuangan yang minim, peranan pengendalian intern dalam menunjang sistem pemberian pembiayaan pada BMT Duta Jaya Unit 2 Tulang Bawang, mendorong efektivitas sistem operasional pembiayaan, mendorong tanggung jawab terhadap laporan keuangan, mendorong kegiatan yang berlangsung sesuai dengan peraturan yang berlaku, pengendalian Intern pada BMT Duta Jaya Unit 2 Tulang Bawang telah sesuai dengan pandangan Islam yaitu pengendalian yang dilakukan dari diri sendiri dan pengendalian dari luar diri sendiri

Interleukin-27 early impacts Leishmania infantum infection in mice and correlates with active visceral disease in humans

The complexity of Leishmania host interactions, one of the main leishmaniasis issues, is yet to be fully understood. We detected elevated IL-27 plasma levels in European patients with active visceral disease caused by Leishmania infantum, which returned to basal levels after successful treatment, suggesting this cytokine as a probable infection mediator. We further addressed this hypothesis recurring to two classical susceptible visceral leishmaniasis mouse models. BALB/c, but not C57BU6 mice, showed increased IL-27 systemic levels after infection, which was associated with an upregulation of IL-27p28 expression by dendritic cells and higher parasite burdens. Neutralization of IL-27 in acutely infected BALB/c led to decreased parasite burdens and a transient increase in IFN-gamma(+) splenic T cells, while administration of IL-27 to C57BU6 promoted a local anti-inflammatory cytokine response at the site of infection and increased parasite loads. Overall, we show that, as in humans, BALB/c IL-27 systemic levels are infection dependently upregulated and may favor parasite installation by controlling inflammation.Fundação para a Ciência e Tecnologia (FCT)/Ministério da Educação e da Ciência (MEC), co-funded by FEDER under the PT2020 Partnership Agreement through the Research Unit NO. 4293; by European Community’s Seventh Framework Programme under grant agreement No. 603182 (Project MuLeVaClin) and by the ISCIII-AES project (project reference PI13/00440). PC and BP-C are supported by fellowships from the European Community’s Seventh Framework Programme under grant agreements No. 603182 (Project MuLeVaClin) and No. 603240-2 (Project NMTryPI